Thoracic Manifestations of Rheumatoid Arthritis

Groner, Lauren K.; Green, Daniel B.; Weisman, Stacey Verzosa; Legasto, Alan C.; Toy, Dennis; Gruden, James F.; Escalon, Joanna G.

doi:10.1148/rg.2021200091

Cited by 15 publications

(42 citation statements)

References 77 publications

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“…For instance, mosaic attenuation and air trapping in the setting of RA is a manifestation of constrictive bronchiolitis and is more common in females, those with positive RF (rheumatoid factor), and longstanding untreated disease. In addition, it can also be due to toxicity with certain medications including gold, penicillamine, rituximab, and sulfasalazine [ 43 ]. This highlights the need for relevant serological testing and a review of patient history to explore non-HP related causes of air trapping.…”

Section: Diagnostic Algorithm and Challenging Scenariosmentioning

confidence: 99%

Hypersensitivity Pneumonitis: A Pictorial Review Based on the New ATS/JRS/ALAT Clinical Practice Guideline for Radiologists and Pulmonologists

2022

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Hypersensitivity pneumonitis (HP) is a complicated and heterogeneous interstitial lung disease (ILD) caused by an excessive immune response to an inhaled antigen in susceptible individuals. Accurate diagnosis of HP is difficult and necessitates a detailed exposure history, as well as a multidisciplinary discussion of clinical, histopathologic, and radiologic data. We provide a pictorial review based on the latest American Thoracic Society (ATS)/Japanese Respiratory Society (JRS)/Asociación Latinoamericana del Tórax (ALAT) guidelines for diagnosing HP through demonstrating new radiologic terms, features, and a new classification of HP which will benefit radiologists and pulmonologists.

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Section: Diagnostic Algorithm and Challenging Scenariosmentioning

confidence: 99%

Hypersensitivity Pneumonitis: A Pictorial Review Based on the New ATS/JRS/ALAT Clinical Practice Guideline for Radiologists and Pulmonologists

2022

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“…(1,21) As manifestações pleurais mais comuns são derrames e pleurisia, com prevalência de aproximadamente 3% e 20%, respectivamente. (4) O derrame pleural pode ocorrer por inflamação pleural (Figura 6), infecções ou doença cardíaca associada à AR em pacientes com AR. Os derrames pleurais secundários à insuficiência cardíaca são geralmente bilaterais, diferentemente dos secundários a inflamações ou infecções pleurais, que são geralmente unilaterais e se apresentam com pequeno volume.…”

Section: Manifestações Pleuraisunclassified

“…Fístulas broncopleurais, imunossupressão e fístulas de doença pleural crônica aumentam o risco de empiema. (1,4)…”

Section: Manifestações Pleuraisunclassified

“…A HAP pode levar à insuficiência respiratória crônica e insuficiência cardíaca direita e raramente é secundária à vasculite da AR. (1,4,22) Os achados tomográficos diretos da HAP são aumento das artérias pulmonares, razão entre diâmetro da artéria pulmonar principal e diâmetro da aorta ascendente > 1, dilatação das câmaras cardíacas direitas e hipertrofia ventricular direita. Sinais indiretos nos pulmões podem ser identificados, como atenuação em mosaico, indicando diferenças regionais na perfusão pulmonar.…”

Section: Hapunclassified

“…(1)(2)(3) A apresentação clínica é heterogênea, variando de ausência de sintomas a insuficiência respiratória progressiva, e pode ter início agudo ou insidioso. (1,4) O acometimento pulmonar na AR geralmente ocorre até cinco anos após o diagnóstico de AR, mas é importante reforçar que pode preceder o acometimento articular. (2,3) Para avaliar as diferentes manifestações pleuropulmonares da AR, a TC é essencial, pois permite não só o detalhamento das lesões, mas também sua localização precisa.…”

Section: Introductionunclassified

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Tomographic pleuropulmonary manifestations in rheumatoid arthritis: a pictorial essay

et al. 2023

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Rheumatoid arthritis (RA) is an autoimmune inflammatory and heterogeneous disease that affects several systems, especially the joints. Among the extra-articular manifestations of RA, pleuropulmonary involvement occurs frequently, with different presentations, potentially in all anatomic thoracic compartments, and may determine high morbidity and mortality. The most common pleuropulmonary manifestations in patients with RA include interstitial lung disease (ILD), pleural disease, pulmonary arterial hypertension, rheumatoid lung nodules, airway disease (bronchiectasis and bronchiolitis), and lymphadenopathy. Pulmonary hypertension and ILD are the manifestations with the greatest negative impact in prognosis. HRCT of the chest is essential in the evaluation of patients with RA with respiratory symptoms, especially those with higher risk factors for ILD, such as male gender, smoking, older age, high levels of rheumatoid factor, or positive anti-cyclic citrullinated peptide antibody results. Additionally, other etiologies that may determine tomographic pleuropulmonary manifestations in patients with RA are infections, neoplasms, and drug-induced lung disease. In these scenarios, clinical presentation is heterogeneous, varying from being asymptomatic to having progressive respiratory failure. Knowledge on the potential etiologies causing tomographic pleuropulmonary manifestations in patients with RA coupled with proper clinical reasoning is crucial to diagnose and treat these patients.

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Oxymatrine ameliorates rheumatoid arthritis by regulation of Tfr/Tfh cell balance viatheTLR9‐MyD88‐STAT3 signaling pathway

et al. 2023

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Background Oxymatrine (OMT) is one of the authentic Chinese herbal medicines which has rich and complex active ingredients. however,the relevant potential targets of oxymatrine on rheumatoid arthritis and the mechanism remains unreported. The aim of this study was to determine the regulation of oxymatrine on rheumatoid arthritis using a collagen‐induced arthritis (CIA) mice models and blood samples from RA patients. Results Our results indicated that Tfr cells in RA patients express low levels of Blimp‐1 and CTLA‐4. Oxymatrine treatment of CIA mice alleviated joint swelling, reduced the arthritis score, and improved joint damage. While flow cytometry results showed that oxymatrine treatment reduced Tfh cells and B cells, and increased Tfr cells in the spleen of CIA mice. In addition, oxymatrine treatment significantly down‐regulated the expression of TLR9（Toll‐like Receptors 9), IL‐21, MyD88, STAT3, p‐STAT3, and CXCR5 in the synovial tissues of CIA mice, and up‐regulated the expression of Foxp3, Blimp‐1, and CTLA‐4. Conclusion Oxymatrine can alleviate rheumatoid arthritis by regulating the TLR9‐MyD88‐STAT3 signaling pathway to maintain immune balance between Tfr‐Tfh cells. © 2023 Society of Chemical Industry.

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Thoracic Manifestations of Rheumatoid Arthritis

Cited by 15 publications

References 77 publications

Hypersensitivity Pneumonitis: A Pictorial Review Based on the New ATS/JRS/ALAT Clinical Practice Guideline for Radiologists and Pulmonologists

Hypersensitivity Pneumonitis: A Pictorial Review Based on the New ATS/JRS/ALAT Clinical Practice Guideline for Radiologists and Pulmonologists

Tomographic pleuropulmonary manifestations in rheumatoid arthritis: a pictorial essay

Oxymatrine ameliorates rheumatoid arthritis by regulation of Tfr/Tfh cell balance viatheTLR9‐MyD88‐STAT3 signaling pathway

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